Here is Part Deux of my 3-part Vlog series on how we can create great culture in Health and Care Systems (or anywhere really!).
“Culture eats strategy for breakfast,” Peter Drucker, but I don’t think we believe this anywhere nearly enough!
Here is Part Deux of my 3-part Vlog series on how we can create great culture in Health and Care Systems (or anywhere really!).
“Culture eats strategy for breakfast,” Peter Drucker, but I don’t think we believe this anywhere nearly enough!
This week I had the privilege of listening to Prof Warren Larkin, advisor to the Department of Health on Adverse Childhood Experiences. This is something I’ve written about on this blog before and Warren has made me more determined than ever to keep talking about this profoundly important issue. This blog draws on his wisdom and learning.
I believe that Adverse Childhood Experiences are our most important Public Health issue. So I want to be really clear about what they are, how and why they affect us so deeply, where we can find help if we’ve been affected by them and how together we can change the future, by preventing them.
What Are Adverse Childhood Experiences?
• Physical abuse
• Sexual Abuse
• Emotional Abuse
• Living with someone who abused drugs
• Living with someone who abused alcohol
• Exposure to domestic violence
• Living with someone who was incarcerated
• Living with someone with serious mental illness
• Parental loss through divorce, death or abandonment
How Common Are They?
The answer is – far too common. There have been some really wide ranging studies across the UK and USA into the numbers of us who have experienced ACEs, and it’s not just in our “most deprived communities” but in predominantly white, middle class areas where we see the stark statistics. Depending on the study you read, between 50 and 65% have experienced at least one ACE. And shockingly 1 in 10 of us have experienced more than 4.
How and Why Do They Effect Us?
Firstly, they affect us by quantity. The more ACEs we experience, the worse our physical, mental and social health and wellbeing is. If you have experienced one ACE, you have an 86% chance of being subject to several. If you experience more than 4, your health and wellbeing is significantly affected. If you experience more than 6 then you have a 46 times higher chance of becoming an IV drug abuser, a 35 times higher chance of committing suicide and an overall 20 year decrease in life expectancy.
Secondly, the toxic stress levels significantly change the way in which our brains grow and function. This has a profound impact on our day to day functioning. ACEs are a massive cause of absenteeism from work, high cost to the health and social care system and highly predictive of time behind bars. That is why so many of us have complex relationships with things like food. Losing weight, for example, is not as straight forward as eating less, exercising more or ending up with a gastric band. Did you know that suicide rates are massively increased after bariatric surgery? By removing the ability to eat, the very thing that takes away or comforts the pain, we expose the underlying issue, but provide no healing into that void.
Thirdly, our bodies literally keep the score of the negative experiences. So, we become more likely to develop chronic pain, inflammatory conditions, heart disease, cancer and mental health issues.
Fourthly, the toxic stress actually alters the way our DNA works and therefore changes the genetic information that we pass onto future generations. As an example, domestic violence in pregnancy is predictive of child developmental issues and offspring of the survivors of the holocaust or genocide are far more likely to develop chronic anxiety. This highlights just how important our family history really is.
Fifthly, there are proven things we can do a) to help our brains learn how to cope in the midst of really difficult circumstances (resilience) and b) therapeutic interventions that can genuinely heal us.
Where Can We Find Help?
Here’s the thing – this is where the rubber hits the road.
Many of us, who have experienced difficult things in childhood/adolescence never talk about them. Sometimes that’s because we can’t remember the experiences – they happen to us before our memories fully form. But perhaps more frequently we bury them because we don’t want to talk about the deeply painful memories, we don’t know how to or we’re worried about what might happen to us, or the people who caused us the pain if we do. And how do you start a conversation like that anyway? What? Are you going to just blurt it out to someone? And what on earth will you do if you just start crying in the middle of a restaurant when you talk to your girlfriend/boyfriend about what happened to you? And what about all those complicated associated feelings of shame, guilt, fear, thoughts of rejection? So…..we keep the lid on….even though it’s to our own detriment because we don’t know how to bring it into the open.
And here in lies the starting place. It’s vital that we learn this in the world of health and social care, but actually we all need to hear this incredible truth. Various studies have shown that it takes 9-16 years for people to be able to talk about trauma/abuse they experienced, but most never do. Fraser and Read found that in their patients struggling with mental health issues, only 8% of them volunteered that they had experienced ACEs. However, when they were actually asked about this, 82% then talked about ACEs they had experienced. So? So, we find it almost impossible to talk about, but when someone asks us about what we have lived through, it takes the lid off the box, peels the sticky plaster off the deep wound and allows us to begin talking about our pain. And here’s something really remarkable……Felitti and Andra found in a study of 140000 people that simply by routinely asking all patients about ACEs, they saw a 35% decrease in visits to the GP and an 11% reduction in use of the Emergency Department!
What does that mean? It means that giving someone the chance to talk about their journey, what they have been through, breaking the cycle of shame, fear and rejection is, in and of itself, deeply healing! Knowing that you’re not a freak, knowing that it wasn’t your fault, knowing that it doesn’t mean that you yourself will become an abuser/alcoholic/poor parent and many more realisations can make a significant difference to a person’s wellbeing. Maybe it doesn’t have to wait for a GP’s surgery or a counsellor’s chair. Maybe, just maybe if we all care enough to ask each other deeper and more caring questions we can help to heal each other. I know this is true of my own journey and that of many of my friends.
But let’s not be naive. For some of us, the experiences we have had are so horrific that we are stuck in a moment and we can’t get out of it. And this is where good therapy really comes in. I wonder if we invested more in therapy and less in drugs to numb our pain, how much more healed we might be – perhaps more expensive in the short term, but overall the cost is far less, both for the individual and society as a whole. There is help available and it can take many forms. EMDR, Trauma Focussed-CBT, Bereavement Counselling and even things like working through a forgiveness process. Unfortunately, many of the waiting lists are very long, and private options are way too expensive for most people to afford.
So, Can We Change The Future?
You know that I believe together we can! But it’s not going to be easy, especially not in the context of our floundering social services, restrictive school curriculums, reduction in numbers of health visitors and school nurses, eye watering cuts to public health budgets and significantly stretched CAMHS and Adult Mental Health Teams. And I think we have to very real and honest about that, because if this is such a massive issue in our society (and the data and evidence is astounding) then we need, as Warren Larkin so eloquently argues, genuine commitment from leaders and organisations to shift towards a culture of learning and collaboration to bring about change.
Here are some things we need to do together:
1) Own up to what a massive issue this is.
2) We need to learn how to ask our friends better questions and care enough to listen to each other’s experiences and journeys because it is really hard to know how to start talking about ACEs, but is more possible when someone bothers to ask!
3) We need to recognise that by bottling things up, we do further harm to ourselves. Perhaps some of our complex addictive patterns of behaviour, our mental health issues, our physical pain and symptoms might well be linked to the ACEs we have experienced. So maybe we don’t need a life on painkillers, cigarettes or with a complex addictive behaviour patterns. Maybe we can find a way to deeper healing.
4) In health and social care, we need to adopt REACh (routine enquiry about adversity in childhood) – we need to change the way we take histories from patients and ask better questions. Remember that even by asking, it doesn’t open up scary and messy consultations that we don’t have time for, actually it opens up a therapeutic space which can massively alter how a person goes on to use the health service in the future.
5) We need to ensure schools are more vigilant to thinking that ‘naughty’ or ‘difficult’ children are actually highly likely to be in a state of hyper vigilance due to stressful things they are experiencing at home. Expecting them to ‘focus, behave and get on with it’, is not only unrealistic, it’s actually unkind. Simply recognising that kids might be having a really hard time, giving them space to talk about it with someone skilled, teaching them some resilience and finding a way to work with their parents/carers via the school nurse/social worker could make a lifetime of difference. It is far more important that our kids leave school knowing they are loved, with a real sense of self-esteem and belonging than with good SATS scores or GCSEs. The academic stuff can come later if necessary and we need to get far better at accepting this.
6) Parenting classes should not just be for the well-motivated or struggling. They should be for all of us – a routine part of antenatal care and alongside our children’s education and include help in dealing with previous ACEs, so they are not repeated for the next generation. Prevention is possible. And that means we need to learn to be a whole lot less judgemental and a great deal more open, honest, vulnerable and restorative with each other. One of my best memories of growing up, was going to a “foster home” for families that my mum used to work with and seeing parents being given the chance to learn how to love their kids, rather than have them taken off them. I know sometimes there is no choice, but helping people learn how to be family and to love and cherish their children is a really beautiful thing. When there has been generational abuse, it is is also of the upmost importance. I’m not saying that a child should never be removed, but we can hardly say that our care system is a rip-roaring success story.
7) We need to find a way of working with men and women in our prisons that enables them to find a way to healing and restoration, not retribution for what are often extremely complex stories.
8) We must learn from best practice around the world. For example, did you know that the vast majority of paediphiles begin offending at the age of 14?! Most of them do not go on to become prolific offenders, but the damage caused to the child they abuse is obviously significant. There is some amazing work now going on in Pennsylvania which has shown that you can actually prevent young men from becoming offenders in the first place. Simply by doing some better sex education, explaining to boys about testosterone, the urges they are having and who it is appropriate to perform sexual acts with; alongside creating a really safe space where they can come and talk about feelings they are having (a bit like AA – with no ridicule or judgement) – data shows that you can decrease the incidence of child sexual abuse. We have to learn from this kind of approach and find a better way of talking about difficult issues. Prevention IS possible!
9) We need to find a way to fund more psychological therapies and become much less reliant on drugs to numb the pain with the associated colossal bill paid to Big Pharma.
This is an area I am really passionate about. I am committing to keep this conversation alive, to ensure that we make a shift in our organisations towards a REACh approach, to find a deeper and more effective partnership with colleagues in education, social services and the police and to create space for more training and awareness for all our staff teams. I know how painful this conversation is, but I also know how utterly damaging it will be if we don’t change the future and prevent this from being a perpetual story through the generations. It is time for the hearts of the elders to turn to the children. Together we can reimagine the future. Together we can.
Here is a really helpful film:
So, the NHS is in another winter crisis.
The Oxford English Dictionary defines a crisis as:
1 A time of intense difficulty or danger.
‘the current economic crisis’
Mass noun ‘the monarchy was in crisis’
1.1 A time when a difficult or important decision must be made. As modifier ‘the situation has reached crisis point’
1.2 The turning point of a disease when an important change takes place, indicating either recovery or death.
Late Middle English (denoting the turning point of a disease): medical Latin, from Greek krisis ‘decision’, from krinein ‘decide’. The general sense ‘decisive point’ dates from the early 17th century.
A crisis is still a crisis, even if you see it coming. What is vital, as per Winston Churchill, is that a) we don’t waste this moment, but allow it to be a true tuning point and b) we don’t rush prematurely to actions to try and solve it, but ensure we look deep enough and far enough and then move towards collective steps for an altogether different kind of future.
I think there are some difficult and inconvenient truths that we need to face up to together. If we can do so, then we can move beyond sensational news cycles into co-producing something really exciting. Here are my incomplete thoughts about where we might want to think about starting:
Happy New Year!
We often start a New Year with resolutions, things which we would like to change for the better. so, I thought I’d start this year of blogging with a vlog about my perspective on the A-Z of what affects your Health and Wellbeing the most.
It’s longer than most of the videos on my new YouTube Channel (Dr Andy Knox), at nearly 15 minutes long, but it is pretty tricky to talk through 26 different aspects of health and wellbeing in under 3 minutes!
So…..he is a list of the things I talk about……and if you don’t want to watch the whole thing, then you can find the bits in the video that are of interest to you, in helping you think about some changes you might want to make or help you might want to access this year.
A is for Alcohol
A is for Adverse Childhood Experiences
B is for Blood Pressure (140/90 – the magic numbers)
C is for Cigarettes
D is for Don’t want to live anymore
E is for Exercise
F is for Fluids
F is for Food
G is for Glucose (Sugar)
H is for Housing
H is for Heating
I is for Irregular Pulse
J is for Joy
K is for Kindness to NHS Staff
L is for Loneliness
M is for Money (Debt)
N is for Narcotics (Drugs)
O is for Obesity/Overweight
P is for Pollution
Q is for Quarrelling
R is for Road Taffic Accidents
S is for Stress
T is for Temper (Anger)
U is for Underweight
V is for Violence (Domestic Violence)
W is for Worry
X is for Xenophobia
Y is for Your Ego
Z is for Zzzzzzzzzzz (Sleep Deprivation)
I’m just returning from 36 hours with the Coalition of Partners for Europe, as part of the World Health Organisation. There were a further 2 days of conversations to occur, but I needed to get back to Morecambe Bay. I have learned so much during my short time with this amazing group of people, some new things and other things learning at a new depth or from a different perspective. I am again bowled over by how using tools from the Art of Hosting can bring a diverse group of people, across languages and cultures together to have really important conversations. Rather than write this in long paragraphs, I’m simply going to bullet my learnings, some of them personal, some more corporate, some amusing, some difficult. One thing is for sure: I know much less than I thought I knew!
1) Finland is 100 years old this year. It has a fascinating history. They also have one of the best Public Health systems in the world and are huge at tackling the social determinants of health. We have much to learn from them and their Scandinavian neighbours.
2) People LOVE the idea of a Culture of Joy! There is a tiredness to the WHO but a recognition across the board that there is a need for cultural change and that culture determines an enormous amount in terms of how well organisations function. Remember a culture of joy is built on good, honest, open, encouraging, kind, approachable and vulnerable leadership, with team members feeling a) that they belong and are loved/valued b) that they are trusted to do their work and c) they share a strong sense of vision.
3) There is wide recognition that Social Movements are vital if we are going to break down health inequalities and see the health and wellbeing of all people improve. We simply cannot come up with ideas in board rooms and ‘do them’ to communities. However, there is also fantastic data and learning available to communtities, which can fuel the social movement. Public Health and Primary care must not sit as separate to or aloof from this emerging movement, but must be a key player and protagonist.
4) When dealing with complex systems, it is good to think of them as gardens instead of machines. To whom does the garden of public health belong? Public Health belongs to the public – it is part of the commons. Therefore communities need to be more involved. There are some great examples of community engagement from across Europe. However, we must move from consultancy to co-production and co-design.
5) Helping people live longer at a poorer quality of life is a pointless goal. The league tables and goals we develop must be co-designed with communities. Our markers of health and wellbeing need some reassessment.
6) People everywhere in the Western world are scared of talking about death and this has huge implications for how we spend money in our health systems.
7) Our European history is so fragile. This causes its own complexities when European people meet together – it all comes into the room with us and requires grace and kindness as we communicate. The quality of relationships within the coalition is fantastic, but more time is needed to develop this.
8) When trying to drink a yoghurt in a taxi, it is important to seal your lips around it well, otherwise you spill it all down your front and look like an idiot.
9) Public health and Primary Care are the bedrock of any health system. I knew this already, but the evidence from around the World is staggering. If these two foundation stones fail, and the staff who deliver these services are not cared for, the entire system collapses.
10) The UK has some of the best public health systems of anywhere in the world. However, the world is watching the decimation of our public health services with dismay. The vital role of prevention and protection that public health has must never be underestimated. If we do not invest in prevention, the consequences for the health system is devastating. The reorganisation of Public Health into our county councils has seen profound cuts to the budgets, as councils have removed the ring fenced budgets. This will almost certainly have detrimental consequences, especially when it comes to tackling our most difficult health and wellbeing issues.
11) When people tell you that all saunas are naked, this may not actually be true and you might end up feeling pretty awkward!
12) We have much to learn from other areas and nations. Shared learning is key. We can do this without competition, hierarchy or lording it over each other.
13) Building good relationships is everything.
14) There is a new generation of leaders emerging who are able to deal with complexity, refusing old silos, borders and hierarchies and finding ways to collaborate through good, honest and vulnerable relationships.
15) We need to learn to hold expertise in one hand and humility in the other. The expertise in epidemiology and the mapping of our health and social issues is vital, if we are going to close the health inequality gaps.
16) Public health is dependent on building partnerships. The wider social determinants of health (poverty, housing, adverse childhood experiences, loneliness, education, environmental issues etc) cannot be tackled by the meagre Public Health budgets. Coalition, collaboration and cooperation across many sectors are necessary for us to begin to tackle these hugely complex social justice issues.
17) Due to public health being underfunded, it leaves it wide open to abuse from those who hold the money strings. Lobbies, donors and national governments hold huge power in determining what does and does not receive funding, often despite the evidence.
18) We need leaders who understand the importance of gift economy and making investments into areas which will not serve their ego nor their profile, but will cause huge benefit to many people.
19) Collecting really good data is important. We need to learn to use it well to shape the conversations and change policy and legislation.
20) Public health holds a hugely important voice in calling governments to account for policy decisions that are to the detriment of a nations health. There is now clear evidence that austerity economics is really bad for people’s physical and mental health and is actually causing people to die. Theory must be challenged hard when evidence does not support it.
21) The poverty truth commission has so much to teach us. No decision about me, without me is for me. this statement made a profound impact on some of the delegates.
22) Doughnut Economics has caught the attention of the coalition.
23) Fazer chocolate is delicious.
24) One of the most challenging truths I learned is that it is often public health workers and doctors/clinicians working on the front line, who are the biggest barriers to working differently with communities and ironically get in the way of the very thing they would love to see happen. This has more to do with the ways we train people to think and work than anything else.
25) Although my talk went well and was hugely well received, I am learning more about the power of story and how to tell our story more effectively.
26) I am grateful that the coalition of partners does not depend on membership of the EU but I am more aware of the pain that Brexit is causing both for me personally and for many friends across Europe.
I understand that Brexit is happening, but day by day it feels to be one of the worst decisions we have ever made as a nation. It is going to cost us over £50 billion to leave, cause untold issues for our ability to trade, decimate the 3rd sector (which btw is the only thing right now stopping our public services from completely collapsing), undo so much great work built through the partnership of our nations and not deliver on any of the false promises made around extra money for our health system or solve our ‘migration issue’. Yes, the EU needs to change, but we have made a monumental error in leaving, rather than reforming it and I still feel we should just apologise and rebuild our bridges rather than burn them.
Narcissus – The Ego Image of Ourselves
Do you know the story of Narcissus? Such a tragedy of a young man, who looked into a pool of water, seeing his image for the first time and found it so mesmerisingly beautiful that he could never bear to look away and died looking at his own reflection. Needless to say, in the world of selfies, it provides a stark warning to us! Its real meaning though is deeper and profoundly challenging.
I have written on this blog a few times about the enneagram and the power it holds in causing us to confront our root issues. In truth, each of us has an ego that we protect and project to the world around us. It is the image of ourselves that we want others to see, the things we would like others to believe of us. But it is only a narcissistic projection, a fake image that we portray, perhaps the image of ourselves that we are in love with or would, perhaps, like others to love. Our life’s work is to own up to the ego we have created and instead become our true selves, which enables us to become a gift to others. This is our deepest, spiritual healing.
My ego projection is that of a Type 7. I project to those around me that I am an enthusiast, an activator, a visionary, full of fresh and new thinking. I am fun and fun loving, I am an activator, a leader and generous. I so easily love this image of myself and what others think and say about me. But truthfully, I am and do those things because I am, for the most part, avoiding pain. There is, if you like, an inner child or shadow, I am trying to protect. A child who didn’t feel content and did not like pain I encountered early in life. So, in order not to feel that pain, I bury my true emotions and project to the world that “I am ok”. I may not be, but I want you to think that I am. And truthfully, I most likely think that I am ok, because I am a “head type” and so I process things very rationally. In any given moment it is often hard for me to know what I actually feel, because I bury my true emotions so that they do not overwhelm me and I do not have to feel any pain. And if you don’t ask me what I’m feeling I don’t have the language to tell you and even if you do, it will take me an enormous amount of energy and courage to really feel whatever it is that I am feeling. And so, in order to bury that pain further I encounter my root sin, which for a Type 7 is gluttony.
This gluttony does not have to be for food, though in my case it often is – I do love food! But it is also a gluttony for fresh or exciting or stimulating experiences – living life to the max. It can lead to such a rushing and business, so that life is never boring and I do not have to be still too long enough to encounter anything particularly negative. This can easily lead to addictive tendencies e.g. to social media, to creating a fantasy world or to always moving onto the next new thing, leaving those around me feeling caught up in the whirlwind or a bit used, abused and taken for granted, whilst the ‘Andy Show’ rolls on through town.
So, what do I do about my narcissistic ego projection that I want the world to believe of me and that I rather love? Well, I can stay as I am. I can continue to let everyone know that “I’m ok”; or I can fall over The Stumbling Stone and receive the invitation to accept just how overwhelmed I feel sometimes; that there is a deep dissatisfaction within me that drives my gluttonous behaviour to cover over my pain. And as difficult as it may be, there is no other salvation for me, no other way to find the simplicity and contentment I long for and to become the gift I can be. Does it mean if I accept that invitation that all my struggles stop, that my ego will die and that my sin will no longer trouble me? Well….yes and no!
There is a death of the ego, but it keeps rearing it’s ugly head and so needs a daily death and some days it dies more than others. And when I’m running from pain and feeling overwhelmed, gluttony of one sort or another will too easily take hold. But always in my path is The Stumbling Stone, inviting me, instead, to walk the narrow path, the path less trodden, the path less looked for because it means walking through a narrow gate in which the ego, I love too much is stripped off me. What I so easily forget is just how heavy and tiring that old ego is. To have it removed with surgical precision and find a way to walk that is so much lighter and less burdensome is pure joy. No more pretence, no more projection, just me, as I am, loved at the very core of my being.
No matter who you are, you too have an ego that you are projecting to the world. Your life’s work is to recognise that ego and choose which path you will walk. For a Type 2 you project that you are loving and helpful. For a Type 3 you project that you are successful and outstanding. For a Type 4 you project that you are sensitive and special. For a Type 5 you project that you are perceptive. For a Type 6 you project that you are reliable, a loyal skeptic. For a Type 7, like me you project that you are enthusiastic. For a Type 8 you project that you are strong. For a Type 9 you project that you are peaceful. For a Type 1, you project that you are honest, hardworking and orderly. The invitation to each of us to fall out of love with our ego and become our true self. Then we can say, like God, I am who I am.
A few months ago, I wrote a couple of blogs exploring the social justice issue that is the vast difference between the health spend in the North, compared to the South.
This week a graph was produced by HM Treasury to show how overall spending has changed across England since 2012. Here is the evidence:
So, in the North, we already have the worst health outcomes in England with an underspend of around £800m per year, per head of population, compared to the South. Yet, over the last 5 years we have seen further disinvestment here at a time when we’re also being asked to make substantial savings! Why the Northern MPs do not seem to think this is worth making much noise about, I’m not quite sure. This is an economic issue, a political issue, a social justice issue and a humanitarian issue. As I take the conversation to our public about the difficult choices ahead of us, here in Morecambe Bay and Lancashire over the coming months, I wonder what the response to this information might be?
Here is a beautiful piece of prose that I have found really helpful over the last year – well worth a read and some time to reflect:
Speed has compensations. Speed gets noticed. Speed is praised by others. Speed is self-important. Speed absolves us. Speed means we don’t really belong to any particular thing or person we are visiting, and thus appears to elevate us above the ground of our labours. When it becomes all-consuming, speed is the ultimate defence, the antidote to stopping and really looking.
If we really saw what we were doing and who we had become, we feel we might not survive the stopping and the accompanying self-appraisal. So we don’t stop, and the faster we go, the harder it becomes to stop. We keep moving on whenever any form of true commitment seems to surface. Speed is also a warning, a throbbing insistent indicator that some cliff edge or other is very near, a sure diagnostic sign that we are living someone else’s life and doing someone else’s work.
But speed saves us the pain of stopping; speed can be such a balm, a saving grace, a way we tell ourselves, in conscious ways, that we are really not participating.
The great tragedy of speed ….is that very soon we cannot recognise anything or anyone who is not travelling at the same velocity as we are…….We start to lose sight of the bigger, slower cycles that underlie our work.
We start to lose sight of family members, especially children, or those who are ill or infirm, who are not flying through the world as quickly and determinedly as we are. We forget that our sanity is dependent on relationships with longer more patient cycles extending beyond the urgencies and madness of the office.
A friend falls sick and in that busyness we find their interruption of our frantic lives frustrating and distracting. On the surface we extend our sympathies, but underneath we are already moving in a direction that takes us far away. We flee the situation even if we are sending flowers every day; we rejoin, thankfully, the world that is on the go, on the move, untouched by mortality.
However, through whatever agency it arrives in our lives – a broken limb, the loss of a loved one, the collapse of our business, a moment of humiliation in the doorway of a meeting room – our identities built on speed immediately fall apart and disintegrate. We find ourselves suddenly alone and friendless, strangers even to ourselves.
David Whyte “Crossing the Unknown Sea”.
In the last blog, reflecting on the book “Legacy”, by James Kerr, I started to explore how the All Blacks have managed to create such an excellent culture; reflecting on what we can learn from it in the health and social care system (or indeed any environment).
Of the 15 principles outlined, I looked at the first 8 (the pack) and now I will look at the back 7.
9) Stay Focussed under Pressure – The eighth principle is to practice under pressure and learn to keep a cool head. This ninth one is about individuals and the team keeping their focus and attention on the task in front of them when the pressure comes. There are times when the stress is on. We are hard pressed from every side. The powers are breathing down our necks, the crisis is in front of us, we feel under resourced, over stretched and at the end of ourselves. Keeping our heads, and not losing them at such times, is the mark of a team who know how to manage themselves and take care of each other. This is really about learning to be mindful, to be present in the moment and to centre ourselves well. At times of real pressure, psychologists recommend three key things: 1) Slow your breathing down and focus on the breath flowing in and out of your body – this calms the mind and brings you into the present. 2) Find a repetitive action, like tapping your foot, scrunching your toes or clicking your fingers to help your body connect to the moment you are in. 3) Rehearse some mantras, which you can repeat back to yourself, over and over, to remind you of the basic things you need to do. That is what we use ABCDEF for in resuscitation – it’s why we need the automatic pilot. It also makes us far less likely to snap at team players and hurt relationships when the proverbial hits the fan.
10) Authenticity – the best leaders stay true to their deepest values, no matter what situation they find themselves in. Honesty = Integrity = Authenticity = Resilience = Performance. Be taken at your word. Say what you mean and mean what you say. Be true to who you are, no matter where you are. To be lovely at work and a terrible person to your spouse or family lacks integrity and authenticity. Good people make good leaders.
11) Sacrifice – now, I would offer a word of caution here. We work in environments in which sometimes we sacrifice our own wellbeing or our own marriages/families due to the pressures and expectations that we put ourselves under, because we are good hearted people who often have the need to be needed or the need to be heroes. However, there is definitely a balance, because without some sacrifice and having the kind of love, which as Thomas Jay Oord puts it, is “self-emptying and others empowering” we will lack something vital in our culture. Buckminster Fuller says we must wrestle with these questions: ‘What is my job on the planet? What needs doing, that I know something about, that probably won’t happen unless I take responsibility for it? What extra mile will make us extraordinary?’
12) Language – Sing your world into existence. I hosted a conversation in Morecambe recently, in which I shared that I often sing to places as I drive or walk through the streets (weird, I know!). But I asked everyone there, that if they were to sing a song to Morecambe, what that song would be. There was nobody without a song! Leaders are storytellers. All great organisations are born from a compelling story. Words and values really matter. Organisations need their own vocabulary, mottos, mantras and metaphors. The food of a leader is knowledge and communication. In Morecambe Bay, we are beginning to develop a language and a narrative around ‘The Bay Way.’ We want our vocabulary and our dialect to reflect the vision, values, culture and behaviours here.
13) Ritual – now, it might be pretty awkward if we all started to try and do the Haka at the start of our meetings! Not only would be awkward but it would make little cultural sense! Even for the All Blacks, the Haka has had to change. The team is no longer predominantly Maori, but a mixture of many cultures. They have had to go on a journey together of how to keeep and adapt a ritual that really means something and connects the team together. Ritual makes the intangible real. It can take many different forms, but it really is vital. It might be a daily team check in, but my sense is that it takes some bravery to establish and continue. In the West, we are so much more detached from our sense of corporate history and identity. Perhaps we feel embarrassed about it or no longer know what it means for us now. What might ritual look like in our work places and teams now? There is a Maori phrase which says: “Tell me and I’ll forget. Show me and I may remember. Involve me and I’ll understand.” This is why I am so keen for our teams to experience things together, like the Art of Hosting. It is in the partaking, the encountering of the ‘other’, the immersion in the experience in which we find ourselves changed.
14) Whakapapa – this is the principle of being a good ancestor. What are you sowing into those around you. The All Blacks make it really clear that becoming an All Black is a privilege not to be taken lightly. When you receive the jersey, it comes with a weight of history and a responsibility that you take it to the next level. The challenge is not to aim for something nice to be written on your grave stone, but for your fingerprints to be left in the lives of those around you, so that the thread of your story is continued. Here are some good words: Care for the land, care for the people. Go forward. Grow and branch forth for the days of your world.
15) Legacy – This is your time. What will you do with it? What will your legacy be?
There is so much to reflect on in the chapters of this book. We are in danger of rearranging the systems in which we work, without dealing with the issues of the heart. I will keep on saying this: Culture is vital. If we do not get our values and our culture right, we build on very shaky foundations and our house will not stand. Taking the time to reflect and build our culture together will enable us to create a legacy for the future that will be beautiful and life giving.